TY - JOUR
T1 - The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy
AU - Mudgway, Ross
AU - Chavez de Paz Villanueva, Carlos
AU - Lin, Ann C.
AU - Senthil, Maheswari
AU - Garberoglio, Carlos A.
AU - Lum, Sharon S.
N1 - Publisher Copyright:
© 2020, Society of Surgical Oncology.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Objective: We sought to examine the impact of primary tumor resection on survival in HER2+ stage IV breast cancer patients in the era of HER2 targeted therapy. Methods: We conducted a retrospective cohort study of women with HER2+ stage IV breast cancer in the National Cancer Database from 2010 to 2012 comparing those who did and did not undergo definitive breast surgery. Results: Of 3231 patients, treatment included primary site surgery in 35.0%; chemo/targeted therapy in 89.4%; endocrine therapy in 37.7%; and radiation in 31.8%. Surgery was associated with Medicare/other government (OR 1.36, 95% CI 1.03–1.81) or private insurance (OR 1.93, 95% CI 1.53–2.42) versus none/Medicaid, radiation (OR 2.10, 95% CI 1.76–2.51), chemo/targeted therapy (OR 1.99, 95% CI 1.47–2.70), and endocrine therapy (OR 1.73, 95% CI 1.40–2.14). Non-Hispanic Black versus White patients (OR 0.68, 95% CI 0.53–0.87) were less likely to have surgery. Overall mortality was associated with insurance (Medicare/other government versus none/Medicaid, HR 0.36, p < 0.0001), receipt of chemo/targeted therapy (HR 0.76, p = 0.008), endocrine therapy (HR 0.70, p = 0.0006), and radiation therapy (HR 1.33, p = 0.0009), NH Black versus White race/ethnicity (HR 1.39, p = 0.002), visceral versus bone-only metastases (HR 1.44, p = 0.0003), and lowest versus highest income quartile (HR 1.36, p = 0.01). Propensity score analysis showed surgery was associated with improved survival versus no surgery (HR 0.56, 95% CI 0.40–0.77). Conclusions: Surgery of the primary site for metastatic HER2+ breast cancer is associated with improved overall survival in selected patients.
AB - Objective: We sought to examine the impact of primary tumor resection on survival in HER2+ stage IV breast cancer patients in the era of HER2 targeted therapy. Methods: We conducted a retrospective cohort study of women with HER2+ stage IV breast cancer in the National Cancer Database from 2010 to 2012 comparing those who did and did not undergo definitive breast surgery. Results: Of 3231 patients, treatment included primary site surgery in 35.0%; chemo/targeted therapy in 89.4%; endocrine therapy in 37.7%; and radiation in 31.8%. Surgery was associated with Medicare/other government (OR 1.36, 95% CI 1.03–1.81) or private insurance (OR 1.93, 95% CI 1.53–2.42) versus none/Medicaid, radiation (OR 2.10, 95% CI 1.76–2.51), chemo/targeted therapy (OR 1.99, 95% CI 1.47–2.70), and endocrine therapy (OR 1.73, 95% CI 1.40–2.14). Non-Hispanic Black versus White patients (OR 0.68, 95% CI 0.53–0.87) were less likely to have surgery. Overall mortality was associated with insurance (Medicare/other government versus none/Medicaid, HR 0.36, p < 0.0001), receipt of chemo/targeted therapy (HR 0.76, p = 0.008), endocrine therapy (HR 0.70, p = 0.0006), and radiation therapy (HR 1.33, p = 0.0009), NH Black versus White race/ethnicity (HR 1.39, p = 0.002), visceral versus bone-only metastases (HR 1.44, p = 0.0003), and lowest versus highest income quartile (HR 1.36, p = 0.01). Propensity score analysis showed surgery was associated with improved survival versus no surgery (HR 0.56, 95% CI 0.40–0.77). Conclusions: Surgery of the primary site for metastatic HER2+ breast cancer is associated with improved overall survival in selected patients.
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U2 - 10.1245/s10434-020-08310-2
DO - 10.1245/s10434-020-08310-2
M3 - Article
C2 - 32157524
SN - 1068-9265
VL - 27
SP - 2711
EP - 2720
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 8
ER -